Document Detail

Neurocutaneous sural flap in paraplegic patients.
MedLine Citation:
PMID:  18562264     Owner:  NLM     Status:  MEDLINE    
Neurocutaneous flaps have been demonstrated to be a reliable option in different groups of patients but it remains unclear if distally-based sural flaps can be safely used in paraplegic patients because they suffer from significant nervous system alterations. The aim of this proof-of-concept study is to demonstrate that these flaps are reliable in paraplegic patients. We prospectively analysed a group (n=6) of paraplegic patients who underwent reversed sural flap surgery for ulcers on the lateral malleolus. Measurement of area and photographic documentation techniques have been employed to quantify the defect area. Sural nerve biopsies have been analysed histologically with several different staining techniques to assess the neurovascular network and the myelinisation of the nerve. The patients showed uneventful wound healing, except one case that suffered a partial flap necrosis that healed by secondary intention. Histologic analysis revealed an intact neurovascular network and myelinated nerve fibres. In this small series of paraplegic patients that underwent a distally-based sural flap, the complication rate was low, with only one case of superficial partial necrosis demonstrating the reliability and safety of the flap in this subset of patients. Histologic evaluation of sural nerve biopsies revealed an almost normal morphology. A possible explanation of this phenomenon is that the dorsal root ganglia remain intact in paraplegic patients and can preserve neural characteristics in the peripheral sensory nerve system.
P Erba; R Wettstein; M Tolnay; U M Rieger; G Pierer; D F Kalbermatten
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Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2008-06-18
Journal Detail:
Title:  Journal of plastic, reconstructive & aesthetic surgery : JPRAS     Volume:  62     ISSN:  1878-0539     ISO Abbreviation:  -     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-07-17     Completed Date:  2009-10-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101264239     Medline TA:  J Plast Reconstr Aesthet Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1094-8     Citation Subset:  IM    
Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Basel, CH-4031 Basel, Switzerland.
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MeSH Terms
Ankle / innervation,  surgery
Leg Ulcer / surgery*
Middle Aged
Paraplegia / complications*
Prospective Studies
Skin Transplantation / methods*
Sural Nerve / physiopathology,  transplantation*
Surgical Flaps* / blood supply,  innervation
Wound Healing / physiology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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